Roles for Health and Safety

Professionals in Bullying Prevention

and Intervention

Health and safety professionals and volunteers are

disturbed about the physical and psychosocial harm

experienced by many youth as a result of bullying 

by their peers.

Bullying among children is aggressive behavior that is

persistent, intentional, and involves an imbalance of

power or strength. Bullying can take many forms such

as: hitting or punching (physical bullying); teasing or

name-calling (verbal bullying); intimidation using

gestures or social exclusion (nonverbal bullying or

emotional bullying); and sending insulting messages

by e-mail (cyberbullying).

There is no one single cause of bullying among

children. Rather, individual, family, peer, school, and

community factors can place a child or youth at risk

for bullying his or her peers. 

Effects of bullying 

Bullying can be a sign of other serious antisocial and

violent behavior. Youth who frequently bully their

peers are more likely than others to

• Get into frequent fights,

• Be injured in a fight,

• Vandalize property,

• Steal property,

• Smoke,

• Use illicit substances,

• Be truant from school,

• Drop out of school, and

• Carry a weapon.

Youth who are the targets of bullying behavior may

exhibit signs of

• Lower self-esteem,

• Feelings of fear,

• School phobia and absenteeism,

• Nightmares and sleeplessness,

• Depression and anxiety, and

• Thoughts of suicide.

Research that considers the full range of bullying

behaviors is finding that bullying in the United States

is widespread and its consequences are more

enduring than suspected. In a nationally

representative survey of school children, nearly 30

percent reported moderate and more frequent

involvement in having been bullied, in bullying or

both within the school year (Nansel, et al; 2003).

Whether they are perpetrators or targets of bullying,

these children face difficulties adjusting to their

environments, socially and emotionally.

Commitments by professional associations

and alliances 

Professional associations in health care and safety are

firm advocates for change whenever evidence

suggests that the well-being of children is

imminently at risk. Persuaded by research about the

nature and prevalence of bullying, several

associations have issued policy directives that

• Instruct primary care providers to be vigilant in

detecting signs of bullying behaviors and

victimization; and intervene early in situations 

of peer bullying to limit adverse influences on

children (see the American Medical Association

2002 Policy Resolution, the National Association

of School Nurses 2003 Issue Brief, and the

Medscape Nurses, 2003).

• Describe screening strategies to identify risk factors

for violence among youth (e.g., family history and

stresses, care and support networks, and reported

exposure to or instigation of malicious behavior).

• Recommend appropriate treatment, referral, and

management protocols for children exhibiting

antisocial and deviant behaviors, including

encouraging parents to adopt prevention 

measures (see American Academy of Pediatrics

1999 Policy Statement).
Additional Policy Information and References 

The American Medical Association issued two policy resolutions, Bullying Behavior Among Youth (D-60.993, 2001) and Bullying Behaviors Among

Children and Adolescents (H-60.943, 2003), that underscore the seriousness of bullying and recommend actions to be taken by AMA, physicians,

parents and caretakers, and coalitions interested in addressing bullying. Retrieved August 12, 2005, from http://www.ama-assn.org/aps (PolicyFinder)

The National Association of School Nurses released an Issue Brief in 2003 about Peer Bullying, which describes the role for school health nurses.

Retrieved August 12, 2005, from http://www.nasn.org/briefs/bullying.htm

The Commission for the Prevention of Youth Violence, consisting of nine of the nation’s largest medical and mental health associations, issued a

commitment from medicine, nursing, and public health in a December 2000 report entitled, Medicine, Nursing, and Public Health: Connecting the dots to

prevent violence. Retrieved August 12, 2005, from http://www.ama-assn.org/violence 

The American Academy of Pediatrics, after a year of study by the Taskforce on Violence, issued a Policy Statement in January 1999 that describes,

The Role of the Pediatrician in Youth Violence Prevention in Clinical Practice and at the Community Level, found in Pediatrics (Volume 103, Number 1, 

p 173-181). Retrieved August 12, 2005, from http://www.aap.org/policy/re9832.html

Muscari, M. (2003). What can I do to help a child who is being bullied? Medscape for Nurses: Ask the Experts. Retrieved August 12, 2005, from

http://medscape.com/viewarticle/451381.

Nansel, T.R., Overpeck, M.D., Haynie, D.L., Ruan, W.J., & Scheidt, P.C. (2003). Relationships between bullying and violence among US youth. Achives

of Pediatric Adolescent Medicine, 157, 348-353. 

These and other materials are available online at: www.stopbullyingnow.hrsa.gov

Challenging new roles in prevention 

Early intervention in detecting risky behaviors by

young adolescents is an essential starting point.

Reversing the behavior patterns of intimidation,

exclusion, and bullying that threaten our youth,

however, will take more than a case-by-case

approach. It will take community-wide strategies 

and nontraditional approaches to prevention to

change cultures that tend to accept, or at least

tolerate, such behaviors within peer groups, 

schools, and communities.

Advocacy and policymaking 

• Be proactive in engaging youth in discussions

about solutions to bullying; encourage youth-led

dialogue and support groups. 

• Oversee the implementation of anti-bullying

policies and practices to dispel misconceptions

about bullying and ineffective practices.

• Take political action to increase resources for

prevention and ensure the sustained funding 

of effective bullying intervention and

prevention programs. 

Early detection and effective intervention 

• Routinely monitor for and intervene quickly when

risk factors are evident for children who bully and

those who are bullied; ask screening questions

during wellness exams and patient visits. 

• Convene multidisciplinary, community-based

coalitions to improve coordination in the

assessment, intake, and referral of children for

treatment, counseling, and other community

services (see Commission for Prevention of 

Youth Violence 2000 report).

• Assist parents and caregivers in responding to signs

of bullying and in accessing a network of support

and resources with attention given to “at-risk” youth. 

Community-wide prevention efforts 

• Consistently apply discipline codes that are more

therapeutic than punitive.

• Make schools, after-school, and youth services

programs “safe zones” where children will be

assured of adequate adult supervision. 

• Support the development of safe school policies and

plans that specifically address bullying behaviors

and bias-motivated harassment or prejudices. 

• Partner with schools to implement comprehensive

bullying prevention programs. 

• Assist in evaluating the impact of interventions

locally and advocate for quality research nationally.

• Promote training and continuing education in

bullying prevention strategies in health safety and

medical fields and as part of clinical supervision

and guidance in teaching programs.